The cars and pickup trucks from Missouri, Tennessee, Arkansas, Louisiana, Indiana and Mississippi started arriving early in the morning at the Alamo Women’s Clinic in Carbondale, Ill. Men were not allowed inside, so most waited in the parking lot, scrolling or dozing, exhausted after driving through the night.

Abortion is legal in Illinois, but the state is surrounded by others that have largely banned the procedure in the three years since the Supreme Court overturned Roe v. Wade. As a result, Illinois now leads the nation in out-of-state abortion patients. Carbondale, a college town in Illinois’s southern tip within driving distance of 10 states with abortion bans, has become a major abortion hub.

Last year three clinics in this city of 21,000 provided close to 11,000 abortions, almost all for women from other states. The numbers, provided by the clinics, account for nearly a third of all out-of-state abortions in Illinois.

Carbondale is an example of how the Supreme Court’s decision, in Dobbs v. Jackson Women’s Health Organization, to end a woman’s constitutional right to abortion has made geography an all-important factor in access to the procedure. After the decision, 14 states effectively banned abortion, a seismic shift that placed Carbondale, a liberal enclave in a deeply conservative region, in a complicated position.

People in the city are generally supportive of its status as a safe harbor. But the sheer number of abortions has also created some unease, and worry about a backlash.

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